Provider Demographics
NPI:1134483274
Name:CITY DERMATOLOGY
Entity type:Organization
Organization Name:CITY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-305-8834
Mailing Address - Street 1:3260 TILLMAN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2029
Mailing Address - Country:US
Mailing Address - Phone:267-332-0321
Mailing Address - Fax:267-332-0323
Practice Address - Street 1:3260 TILLMAN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2029
Practice Address - Country:US
Practice Address - Phone:267-332-0321
Practice Address - Fax:267-332-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103088884-0001Medicaid
PA103088884-0001Medicaid